| ObjectiveThe detection of intestinal mucosal injury markers,peripheral serum bacterialendotoxin,peripheral blood T lymphocyte subsets,inflammatory markers and serum inflammatory factors in patients with severe cerebral infarction was used to explore the correlation between mucosal damage and peripheral immune inflammatory response in patients with severe cerebral infarction on the third day.Methods1.Twenty patients with severe cerebral infarction who were hospitalized at the stroke center of Subei People's Hospital from August 2018 to October 2019(severe cerebral infarction group)and community stroke screening population(control group)were included in the study.Collected their basic clinical data.Patients with severe cerebral infarction were admitted within 24 hours of onset and exclude the infections of other systems,peripheral venous blood was collected in the early morning of the third day.2.Detection of intestinal mucosal injury markers D-lactic acid(D-LA),intestinal fatty acid binding protein(I-FABP)in peripheral venous serum;bacterial endotoxin(ET);Interleukin-6(IL-6),Tumor necrosis factor-?(TNF-?);High-sensitivity C-reactive protein(hs-CRP),and peripheral blood T lymphocyte subsets(CD3~+CD4~+T lymphocyte ratio,CD3~+CD8~+T lymphocyte ratio and CD3~+CD4~+/CD3~+CD8~+).3.Compare the serum serum intestinal mucosal injury markers,serum bacterial endotoxin,serum inflammatory factors and T lymphocyte subsets in the severe cerebral infarction group and the control group.4.To explore whether the serum markers of intestinal mucosal injury in the severe cerebral infarction group are related to serum bacterial endotoxin,serum inflammatory factors,and T lymphocyte subsets.5.To explore whether serum bacterial endotoxin is related to peripheral blood inflammatory factors and peripheral blood T lymphocyte subsets in severe cerebral infarction group.6.To explore whether the inflammatory factors in peripheral serum of patients with severe cerebral infarction are related to the peripheral blood T lymphocyte subsets.Results1.Peripheral serum intestinal mucosal injury marker D-lactic acid in patients with severe cerebral infarction on the third day 38.48±4.94 umol/L was significantly higher than the control group 30.57±3.12 umol/L,the difference was statistically significant(P<0.01),and peripheral serum intestinal fatty acid binding protein levels in the severe cerebral infarction group and the control group were 191.37±22.99 ng/ml and 199.91±16.98 ng/ml and there was no statistical difference(P>0.05).2.On the third day of severe cerebral infarction,the level of peripheral serum inflammatory factor IL-6 was 3.43±6.26 pg/ml,which was significantly higher than that of the control group 1.57±0.70 pg/ml.The level of high-sensitivity C-reactive protein was 18.93±16.01 mg/L,which was higher than the control group by 0.34±0.49mg/L,and the differences were statistically significant(P<0.01).The level of serum inflammatory factor TNF-?in severe cerebral infarction group and control group were0.76±4.14 pg/ml and 0.76±1.38 pg/ml and there was no statistical difference(P> 0.05).The proportion of CD3~+CD4~+T lymphocytes in peripheral blood of severe cerebral infarction group was 55.52±8.24%lower than the control group 65.03±10.84%,and the proportion of CD3~+CD8~+T lymphocytes was 40.63±10.99%higher than the control group 30.46±10.50%,the difference was statistically significant(P<0.05),and the value of CD3~+CD4~+/CD3~+CD8~+was 1.33±0.67 in the severe cerebral infarction group and 2.52±1.19 in the control group and the difference was statistically significant(P<0.01).3.Correlation analysis of peripheral serum intestinal mucosal injury marker D-lactic acid with serum bacterial endotoxin,serum inflammatory factor IL-6,T lymphocyte subsets and hypersensitive C-reactive protein on the third day of severe cerebral infarction showed that peripheral serum D-lactic acid was not related to serum Bacterial endotoxin(r=0.368,P=0.110),serum inflammatory factor IL-6(r=0.115,P=0.629),CD3~+CD4~+T lymphocyte ratio(r=0.157,P=0.508),CD3~+CD8~+T lymphocyte ratio(r=-0.182,P=0.442),the value of CD3~+CD4~+/CD3~+CD8~+(r=0.140,P=0.556)and high sensitivity C-reactive protein(r=0.001,P=0.097).4.On the third day of severe cerebral infarction,the peripheral serum bacterial endotoxin of 15.04±1.22 pg/ml was significantly higher than the control group of 13.59±0.95 pg/ml,and the difference was statistically significant(P<0.01).Spearman correlation analysis showed that peripheral serum bacterial endotoxin level was correlated with peripheral serum IL-6 levels(r=0.533,P=0.016),and were not related to serum TNF-?(r=0.227,P=0.336),hypersensitive C-reactive protein(r=0.425,P=0.062),proportion of CD3~+CD4~+T lymphocytes(r=0.084,P=0.724),proportion of CD3~+CD8~+T lymphocytes(r=0.050,P=0.833)and the value of CD3~+CD4~+/CD3~+CD8~+(r=0.084,P=0.723).5.Analysis of the correlation between peripheral serum IL-6 level and peripheral lymphocyte subsets on the third day of severe cerebral infarction,the level of peripheral serum IL-6 was not related to CD3~+CD4~+T lymphocytes(r=0.049,P=0.838),CD3~+CD8~+T lymphocyte ratio(r=-0.157,P=0.508)and the value of CD3~+CD4~+/CD3~+CD8~+(r=-0.280,P=0.232).Conclusions1.The peripheral serum level of intestinal mucosal barrier injury marker D-lactic acid in patients with severe cerebral infarction on the third day was higher than that in the control group,suggesting that intestinal mucosal barrier injury exists in patients with severe cerebral infarction.2.Compared with the control group,Peripheral serum inflammatory factors IL-6and high-sensitivity C-reactive protein in patients with severe cerebral infarction increased on the third day.The proportion of CD3~+T lymphocytes in peripheral blood significantly changed,and the proportion of CD3~+CD4~+T lymphocytes decreased,the proportion of CD3~+CD8~+T lymphocytes increased,and the value of CD3~+CD4~+/CD3~+CD8~+decreased,suggesting that the peripheral immune inflammatory response of patients with severe cerebral infarction existed on the third day.3.The peripheral serum bacterial endotoxin level in patients with severe cerebral infarction was higher than that in the control group,and it was related to the level of peripheral serum inflammatory factor IL-6,suggesting that the increased bacterial endotoxin level in peripheral serum may promote the release of inflammatory factors... |
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